Amonyous Abdelmalak
Individual provider Active NPI Pharmacist · Tampa, FL
NPI 1831565787 · NPPES record last updated Aug 14, 2015
Key facts
- NPI
- 1831565787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PSI 29724 (FL)
- Practice address
- 9811 Ashburn Lake Dr
Tampa, FL 33610-5911 - Phone
- (813) 505-6684
- NPI assigned
- Aug 14, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSI 29724 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virgin Marys Pharmacy Corp | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PSI 29724 | FL | Yes |
Addresses
Primary practice location
9811 Ashburn Lake Dr
Tampa, FL 33610-5911
Mailing address
9811 Ashburn Lake Dr
Tampa, FL 33610-5911
Phone (813) 505-6684
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSI 29724 | Other | FL | FLORIDA DEPARTMENT OF HEALTH |
Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.